HONG KONG -- This glamorous Asian city is known for its mouth-watering dim sum. Its high fashion. And its 100-pound-and-under women.
Agatha Yau, a marketing executive, is one of these women. She has done many things over the years to stay trim: taken diet pills, eaten meals of boiled vegetables and practiced delaying gratification.
"Sometimes, I'll look at the food and just smell it," Yau, 22, says one morning as she has her breakfast -- a skim caramel macchiato from Starbucks. "I think to myself that once I get married and have kids, I'll be able to eat it" because there'll be less pressure to diet.
"Guys here are so small and skinny," she adds. "They need to feel masculine, and they don't if you're bigger than them."
In most developed parts of the world, women feel pressure to be thin. But such pressure is especially intense in Asia -- in places like Hong Kong, Seoul and Tokyo -- where scores of skinny women seem always to be looking for ways to get even skinnier. Experts say dieting in Asia tends to be more extreme than in the West because of cultural perceptions of beauty.
"The magic number is to be below 100 pounds, no matter your height or your weight," says Philippa Yu, a clinical psychologist at the Hong Kong Eating Disorders Association.
In Asia, women want to stay skinny without exercising because muscles aren't considered a feminine feature, says Sing Lee, director of the Hong Kong Eating Disorders Center at Chinese University.
That's why, "when they want to control their body weight, they eat less or take pills" instead of exerting themselves, Lee says.
Hong Kong dieters also flock to slimming centers throughout the city for ultrasound, electrical stimulation and infrared radiation treatments that promise to whittle away inches of fat. (The Hong Kong Consumer Council has called some of the slimming centers' weight-loss claims "dubious.")
The newest dieting fad in Hong Kong? Swallowing parasites. This radical form of weight loss has become popular enough that the Hong Kong Health Department issued a warning in February that these worms -- which are sold on Chinese websites -- can cause abdominal pain, vomiting, diarrhea and even death.
Eating disorders on rise
As extreme weight-loss methods take hold in Asia, eating disorders are also increasing.
In Beijing, at Peking University's Institute of Mental Health, more than 100 patients were hospitalized last year for eating disorders, says Darong Zhang, director of the institute's treatment center. That compares with about 20 patients hospitalized 10 years ago.
In Hong Kong, the number of patients treated for eating disorders at one clinic has nearly doubled -- to 128 -- from 1998 to 2007 when compared with the prior 10-year period, Lee's research shows.
Eating disorders also are becoming more common in Korea, but many women don't want to admit they have a problem, says Mirihae Kim, a psychology professor at Duksung Women's University in Seoul.
"The last time I tried to run an eating disorder group, only one person showed up," Kim says. "So I changed the group's name to Overeaters Group Therapy."
The reality is that in Korea, being thin is the "main standard of beauty," Kim says. "People say that if you are overweight, you can't study, you will fail the exam. That's the attitude here."
Koreans also say weight plays an important role in whether someone can find employment and how good a job he or she can get.
Duksung Women's University senior Hyun-Jung Lee, 25, says she's dieting because she wants to land a job as a sales representative for a pharmaceutical company.
"If I am in good shape, other people will judge me as diligent and successful in life," says Lee, who is 5 feet, 4 inches tall and weighs 150 pounds. "But on the other hand, if I am fat and out of shape, people will think: 'She's lazy. Maybe she doesn't care about herself.' "
Unlike others, Lee says she's choosing the "healthy" way to lose weight. She eats low-fat food and exercises five times a week, two hours each time. She has lost about 10 pounds and hopes to lose an additional 22 pounds.
"The better you look, the more opportunity you have," she says.
As Asian societies become wealthier -- and people have more options about what to eat -- it's only natural that some will struggle with their weight, experts say.
A new kind of competition
With the shift from an agrarian to an urbanized society, "there are definitely more opportunities to overeat," says David Schlundt, an associate psychology professor at Vanderbilt University in Nashville, who researches eating habits.
In Asia, obesity is becoming more common among adolescents, although it's less of a problem than in the USA. For now, in cities such as Hong Kong, health professionals say their biggest challenge is dealing with young women who don't eat enough, not those who eat too much.
"You can see how pervasive slimming is in this culture," says Yu, of the Hong Kong Eating Disorders Association. In the old days, Asian women competed with one another to see how many children they could have, but now they compete to be the most successful, and the thinnest, she adds.
Slimming centers have cropped up all over Asia to cater to such desires.
In Shanghai, at Chuanye Slimming Center -- a popular Chinese chain -- women buy packages of 10 sessions. They can choose from treatments such as "ultrasonic liposuction," which claims to vibrate your fat away, or one in which they're covered with Chinese herbs and bandages, then encased in an Austin Powers-esque, heat-emitting machine that's said to draw out toxins while toning the body.
During the treatments, "we don't recommend exercise because it'll turn into muscle," says manager Xu Wenli, whose clients include brides-to-be who are eager to fit into their wedding dresses. "After you lose a certain amount of weight, then you can exercise."
Another slimming center, Marie France Bodyline, which has locations throughout Asia, promises results with "no vigorous exercise." One treatment applies heat and a pulsating suction to remove 2 inches of body fat after just one treatment, the company's brochure says.
Wing Yim, a customer service manager at a Marie France slimming center in Hong Kong, says that women want to be thin, but they already work long hours, so they "don't want to sweat" to achieve their goal.
Yau, the Hong Kong marketing executive, says slimming centers are too expensive (a package of treatments can cost hundreds to thousands of dollars) and she's not sure they work. So she loses weight the inexpensive way, she says: via portion control. For dinner sometimes, she'll have two spoonfuls of rice with vegetables and soup.
"Dieting is a life-long career for women," Yau says. "It's true for women everywhere, but especially in Hong Kong."
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